Renal Failure without CC/MCC DRG Reimbursement Guide

Summary & Overview

Renal Failure without CC/MCC: Inpatient Reimbursement Overview

DRG 684 addresses inpatient stays for renal failure without Major Complication or Comorbidity or Complication or Comorbidity, encompassing acute and chronic renal insufficiency of moderate severity. Proper coding and documentation determine assignment to this Diagnosis-Related Group and therefore influence Medicare reimbursement under the inpatient prospective payment system.

Renal Failure without CC/MCCDRG Renal Failure without CC/MCCDRG 684Diagnosis-Related GroupInpatient ReimbursementMedicareNephrologyDialysisAcute Kidney InjuryChronic Kidney Disease

DRG 684 Overview

DRG 684 covers inpatient admissions for renal failure without a major complication or comorbidity and without a complication or comorbidity. It includes patients treated for acute or chronic renal insufficiency when no higher-severity diagnoses are present. This Diagnosis-Related Group matters for Medicare payment because it groups cases of moderate clinical complexity into a standardized reimbursement pathway under prospective payment. Accurate coding of renal failure and exclusion of Major Complication or Comorbidity and Complication or Comorbidity affects case assignment and payment level.

National Payment Rates

Benchmark payments across commercial payers span roughly from about $1.1K (BCBS p25) up to $24K (Anthem max), with payer medians generally between about $5.7K and $11K. The widest spread appears between Anthem’s maximum ($24K) and BCBS’s lower quartile (~$1.1K), indicating considerable variation across payers. See the table and chart below for payer-specific distributions and percentile detail.

Mean Rates by Payer — National — DRG 684

The CMS 2023 data represent national Medicare fee-for-service inpatient payments published under the CMS Provider Utilization and Payment Data program. The table below shows average total payment, average submitted covered charges, average Medicare payment amount, and total discharges for DRG 684. Values reflect national aggregates for Medicare FFS cases in 2023.

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Alaska’s payer means for DRG 684 range from 9.3K (Anthem and Blue Cross Blue Shield) up to 14K (Cigna), a spread suggesting meaningful regional variability across payers. Cigna’s mean of 14K stands out as higher than many national benchmark means shown for comparable payers. Reference the table and chart below for payer-specific percentiles and distribution detail.

Key Insights for Alaska

Cigna is the highest-paying payer in Alaska with a mean of 14K, while Anthem and Blue Cross Blue Shield are the lowest-paying payers at 9.3K.
Alaska’s mean rates span a relatively wide range (9.3K to 14K), with Cigna notably above the national mean benchmarks for some payers, indicating higher regional reimbursement for DRG 684 compared with several national averages.

Clinical Trials

Acute supportive care trials investigating timing and modality of renal replacement therapy (RRT) for hospitalized patients with acute renal failure without major comorbid complications. These studies enroll adult inpatients with new-onset acute kidney injury attributed to sepsis, ischemia, or nephrotoxins who do not meet criteria for CC/MCC, comparing early versus standard initiation of intermittent versus continuous RRT or optimized conservative management. Findings inform acute management protocols, resource utilization in the inpatient setting, and short-term costs that directly affect DRG-level reimbursement and bed-level planning for hospitals and payers.
Comparative effectiveness research comparing fluid management strategies, diuretic protocols, and nephrotoxin stewardship to prevent progression of renal dysfunction in medical and surgical inpatients. Trials or pragmatic studies focus on heterogeneous ward and ICU populations without major complications, assessing outcomes such as recovery of renal function, need for RRT, length of stay, and readmission rates. This research is relevant to clinicians and payers because modest changes in progression rates and LOS among this DRG cohort can substantially impact hospitalization costs and downstream utilization.
Post-discharge outcomes and care-transition studies tracking recovery trajectories, outpatient follow-up strategies, and readmission prevention for patients discharged after an episode of renal failure without CC/MCC. Cohort studies and interventional trials evaluate models like early nephrology follow-up, home-based monitoring of kidney function and medication reconciliation, and patient education to reduce 30–90 day readmissions and progression to chronic kidney disease. Results guide discharge planning, bundled payments, and payer decisions about coverage for post-acute services that can reduce avoidable rehospitalizations and long-term dialysis initiation.

Related Codes

697-URETHRAL-STRICTURE

Urethral Stricture: Inpatient Reimbursement Overview

669-TRANSURETHRAL-PROCEDURES-WITH-CC

Transurethral Procedures with CC: Inpatient Reimbursement Overview

665-PROSTATECTOMY-WITH-MCC

Prostatectomy with Major Complication or Comorbidity: Inpatient Reimbursement Overview

694-URINARY-STONES-WITHOUT-MCC

Urinary Stones without MCC: Inpatient Reimbursement Overview

700-OTHER-KIDNEY-AND-URINARY-TRACT-DIAGNOSES-WITHOUT-CC-MCC

Other Kidney and Urinary Tract Diagnoses without CC/MCC: Inpatient Reimbursement Overview

651-KIDNEY-TRANSPLANT-WITH-HEMODIALYSIS-WITHOUT-MCC

Kidney Transplant with Hemodialysis without MCC: Inpatient Reimbursement Overview

657-KIDNEY-AND-URETER-PROCEDURES-FOR-NEOPLASM-WITH-CC

Kidney and Ureter Procedures for Neoplasm with CC: Inpatient Reimbursement Overview

654-MAJOR-BLADDER-PROCEDURES-WITH-CC

Major Bladder Procedures with CC: Inpatient Reimbursement Overview

662-MINOR-BLADDER-PROCEDURES-WITH-MCC

Minor Bladder Procedures with MCC: Inpatient Reimbursement Overview

689-KIDNEY-AND-URINARY-TRACT-INFECTIONS-WITH-MCC

Kidney and Urinary Tract Infections with MCC: Inpatient Reimbursement Overview

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Average Total Payment	Average Submitted Charges	Average Medicare Payment	Total Discharges
$5.9K	$27K	$4.1K	7.2K

State Payment Rates

State: Alaska1 / 49

Alaska Benchmarks

Mean Rates by Payer — Alaska — DRG 684

Key Insights for Alaska

Cigna is the highest-paying payer in Alaska with a mean of 14K, while Anthem and Blue Cross Blue Shield are the lowest-paying payers at 9.3K.
Alaska’s mean rates span a relatively wide range (9.3K to 14K), with Cigna notably above the national mean benchmarks for some payers, indicating higher regional reimbursement for DRG 684 compared with several national averages.

Clinical Trials

Acute supportive care trials investigating timing and modality of renal replacement therapy (RRT) for hospitalized patients with acute renal failure without major comorbid complications. These studies enroll adult inpatients with new-onset acute kidney injury attributed to sepsis, ischemia, or nephrotoxins who do not meet criteria for CC/MCC, comparing early versus standard initiation of intermittent versus continuous RRT or optimized conservative management. Findings inform acute management protocols, resource utilization in the inpatient setting, and short-term costs that directly affect DRG-level reimbursement and bed-level planning for hospitals and payers.
Comparative effectiveness research comparing fluid management strategies, diuretic protocols, and nephrotoxin stewardship to prevent progression of renal dysfunction in medical and surgical inpatients. Trials or pragmatic studies focus on heterogeneous ward and ICU populations without major complications, assessing outcomes such as recovery of renal function, need for RRT, length of stay, and readmission rates. This research is relevant to clinicians and payers because modest changes in progression rates and LOS among this DRG cohort can substantially impact hospitalization costs and downstream utilization.
Post-discharge outcomes and care-transition studies tracking recovery trajectories, outpatient follow-up strategies, and readmission prevention for patients discharged after an episode of renal failure without CC/MCC. Cohort studies and interventional trials evaluate models like early nephrology follow-up, home-based monitoring of kidney function and medication reconciliation, and patient education to reduce 30–90 day readmissions and progression to chronic kidney disease. Results guide discharge planning, bundled payments, and payer decisions about coverage for post-acute services that can reduce avoidable rehospitalizations and long-term dialysis initiation.